• Mr. Pascal Javerliat, • Mr. Jean-Paul Orliac, • Mr. Laurent Le

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• Mr. Pascal Javerliat, • Mr. Jean-Paul Orliac, • Mr. Laurent Le Powered By Docstoc
					The National Council of the French Register of Osteopaths (R.O.F.) guarantor of the ethical and
professional conduct of its members considers that it is indispensable, in view of the forthcoming
regulations, to establish:


The competence which guarantees safety and quality of care for the patient is one of the essential
principles of professional and ethical conduct. It justifies the trust which underlies the therapeutic
relationship linking patient and osteopath.

    Without knowledge, without know-how, without knowing how to be, there is no competence.
                            Without competence, there is no quality.
                              Without quality, there is no security.

A high quality osteopath is necessarily a competent osteopath.

This competence is not only individual, but also collective.

With this document, the National Council of the French Register of Osteopaths wishes to enlighten
the reader, and in so doing bring a degree of visibility to this profession which is now legally
recognised. It has been written by:

   •   Mr. Pascal Javerliat,

   •   Mr. Jean-Paul Orliac,
         General Secretary

   •   Mr. Laurent Le Solleu,

   •   Ms. Juliette Canet-de Crozals,
         Vice President

   •   Ms. Marianne Montmartin,
         Vice President

   •   Mr. Philippe Bolet,
         Vice President

With the collaboration of:

   •   Danièle Ganem-Chabenet,

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                        1

1. INTRODUCTION …………………………………………………………….. 3

2. STRUCTURE AND CONTENT……………………………………………... 4




6. VALIDATION COMMITTEE ………………………………………………... 31

                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004          2
                                                                      1) INTRODUCTION
Osteopaths who are members of the French Register of Osteopaths (R.O.F.) exercise their
profession in conformity with the ethical and professional regulations set out in a charter
established by the R.O.F. and known as the Code of Practice. The R.O.F. has the responsibility of
assuring that its members abide by these regulations.

Since the passing of Law 2002-303, 4th March 2002, concerning patient’s rights and the quality of
the health service, the title of osteopath and the practice of osteopathy in France is now authorised
for practitioners who are not medical doctors but have fulfilled certain conditions established by
decree (Article 75). The aim of this legislation is both to offer health service users certain
guarantees concerning the safety and quality of osteopathic care, and to realign France with other
countries that have already recognised osteopathy as a profession. However, the conditions
stated in article 75, Law 2002-303, 4th March 2002 will only fully come into practice once the
decrees have been established.

In the meantime, the osteopathic profession is examining its own evolution and the responsibilities
that it will assume in future health care. In order to integrate the profession into the
multidisciplinary health care system, it is first necessary to define osteopathy in terms of other
professionals and health care professions, in such a way as to qualify both their similarities and

Most of the existing methods used to define a profession seek to identify as astutely as possible
their mode of operation and to draw up a list of the requisite knowledge and understanding
(theoretical and practical curriculum). One particular problem arises from the diversity of
knowledge and practical skills. The description / comparison serves only to highlight the
analogous aspects of different professions. The risk here is to view one profession as simply a
part of another, when in fact this is not the case. Even if certain aspects are common to both
professions, other aspects which are absent from the description or poorly described, will
differentiate them. At the same time, in order to fully define a certain competence it is necessary to
evoke, in addition to knowledge and practical skills, the quality of “savoir être” (knowing how to be)
which is by its nature, specific to an individual and a profession.

In order to resolve this difficulty, the most appropriate method is to analyse the cognitive skills
required to orientate strategies for problem-solving, and consciously or unconsciously guide the
actions that the person performs. This approach permits a greater scope of reflection and avoids
limiting it to one operational gesture only, which would be too restrictive. It allows for an expansion
of practical knowledge further than the boundaries classically analysed in the context of

Cognitive skills are present in all actions whether they be manual, intellectual or relational, and
characterise both the individual and their profession. These skills are transferable if the individual
changes profession, and may to a certain extent overlap between one profession and another.

However, once these skills are applied for osteopathic purposes, they are channelled towards the
concept that is specific to this profession. The therapeutic process which results from this cannot
therefore be confused with any other.

The production of the Standard of Proficiency in Osteopathy 2004 has been largely inspired by the
following documents :
     1. The Code of Practice of the French Register of Osteopaths
     2. The Code of Public Health
     3. Standard 2000 of the General Osteopathic Council (GOsC)
     4. Operational Directory for Professions and Work (ROME)
     5. Référentiel profession ostéopathe (RPO)

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                         3
                                                  2) STRUCTURE AND CONTENT

By analysing the context of professional practice it is possible to determine the dominant areas of
cognitive skills required by the profession and its practitioners. With this aim in mind, a methodical
study has been made concerning the requirements of an osteopath in the different situations with
which they are faced in professional practice.

The Standard 2004 is structured using descriptions relating to practice context :
   • Reference points of knowledge (A,B,C)
   • Ethical concerns (D,E,F,G,H,I,J,K)
   • Professional conduct (L,M,N,O,P,Q,R,S,)

A description of osteopathy as a profession, similar to those used to present other professions in
the Operational Directory of Professions and Work, is presented as a summary.

Due to the recent legal recognition of the profession, certain areas will carry new emphasis, such
    • Accountability, which is currently under discussion as part of the proposed legislation
        concerning modernisation of the health system,
    • An obligation by the practitioner to conform to certain criteria concerning the practice of
        osteopathy and the sanitary environment of the patient.


This document aims to show that osteopaths consider themselves as part of the wider health care
community. This is particularly important with the advent of state sanctioned self-regulation for
osteopaths within the health care community.

This carries with it new responsibilities for practitioners such as :
   • Acknowledgement of their legal and moral responsibilities to their patients,
   • Commitment to maintaining competence and continuing professional development,
   • Adoption of a self-critical stance to their professional work.

2.2 PRACTICE DEVELOPMENT ( A, B, C, D, E, F, L, M, N, O, P, Q )

A number of changes and improvements have occurred in the delivery of osteopathy over the past

Some of the categories of capability attempt to recognise new developments:
  • Recognition of validated scientific data
  • Application of clinical evaluation procedures which take into account advances in medical

At the same time, without being contradictory, other categories reinforce the need to apply the
founding principles of osteopathy recognised by the profession:
    • A commitment to consider the patient from a holistic viewpoint,
    • Identification of the cause of the dysfunction, wherever possible, rather than simply an
       analysis of the symptoms,
    • Emphasis on the importance of palpatory perception as a therapeutic tool.

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                         4

Osteopathy is no longer perceived to be working in isolation from other health care providers, and
is from now on considered to be an integral part of the health care system. In addition, osteopathy
is no longer seen as uniquely curative.

This document recognises these facts and emphasises the need for:
   • Interprofessional collaboration between practitioners within a practical interface, as well as
   • A more structured commitment to helping patients maintain their health.

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                          5

The areas of capability are presented in two parts.

The first part provides a summary of the specific capabilities of the osteopathic profession, in other
words the dominant activities, in relation to the osteopathic context.

The second part analyses the dominant areas of cognitive skills. As far as possible, these are
analysed in the context of different situations relevant to osteopathic practice.


The description of the areas of capability is accompanied by 4 stages which characterise the
degree of competence for that particular area.

These stages do not refer to a certain level of intelligence:

       Level 4: this refers to an awakening, a sensitisation. It corresponds to a general knowledge
              and understanding: “I know, I’ve heard about”.
       Level 3: this refers to a practical application. It corresponds to an aptitude in applying rules,
              conventions, codes and regulations…It requires a deeper understanding of these
              aspects and an awareness of the underlying theoretical elements: “I practise, I have
              the know how”.
       Level 2: this refers to competence. It corresponds to an understanding of the underlying
              logic concerning a specific action, the theory behind practical applications and
              transmission of this knowledge in a professional context, as well as an awareness of
              the existence of other domains which may or may not be complementary to the
              area: “ I understand, I am competent”.
       Level 1: this refers to expertise. It corresponds to an understanding and competence
              concerning the fundamental essential mechanisms, the principles of one domain in
              relation to another, in order to promote an evolution of knowledge and to teach this
              at an advanced level: “ I promote evolution and I teach”.


When one looks directly at the different areas of capability, certain aspects appear to be
continuously repeated. This may be explained by the fact that there is a correlation between the
criteria of capability and a need for these criteria to be fulfilled in diverse circumstances. It is the
interworking of these criteria which define the cognitive skills of a profession, not simply their
juxtaposition. One should therefore examine these criteria in the context of the whole coherent
system and not as individual, independent elements.

In addition, each description of an area of capability should be able to be taken from the document
and used independently as a specific file.


Seven criteria have been used to characterise osteopaths and their profession, in terms of the
cognitive skills that are required.

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                          6

The intellectual thought processes undertaken by an osteopath in the practice of osteopathy are
essentially of two types: application and transposition.

•   Application:

The practice of osteopathy results from a process of application. The procedure for problem
solving is precisely defined and necessitates a clear representation of the aim to be achieved. By
continually referring to a model of health, physiology homeostasis…. osteopaths are aware of what
they have to achieve.
Their action requires them to continually reconsider their objective, integrate new information and
compare this with information already held.

The intellectual process involved is of the type application-production- agility since the practice of
osteopathy requires a procedure that is totally mastered in terms of use of the body, action, agility
and dexterity. This does not a result from an intellectual process of application-production-force-
agility because force is not a requirement for practice.

The intellectual process of application-diagnosis is also dominant as the thought process enables
an osteopath to determine the cause of the patient’s presenting complaint. In addition, the aim is
not to regulate all body systems, but rather to look for the cause of the complaint with reference to
a standard static and dynamic model.

The intellectual process of application-regulation is solicited as the practice of osteopathy must
take into account several interdependent systems, with the aim of enabling them to function
together through the use of one or more procedures.

On the other hand, the intellectual process of application- procedure is rarely solicited as the
procedures are applied according to the needs of each patient and therefore cannot strictly follow a
pre-determined protocol.

•   Transposition

The practice of osteopathy follows a process of adjustment. The activities which motivate this
process rely upon a clear picture of the aim to be achieved, but with numerous options as to how to
obtain this.
Several solutions may be applicable to the same problem, depending upon on the context,
circumstances, conditions….. the choice of solution is that which is best adapted to the patient.

The intellectual process of transposition – analysis is dominant because the osteopathic thought
process is centred upon an understanding of information formulated or revealed by the patient.

The intellectual process of transposition – formalisation is present in the practice of osteopathy as
the implementation of potential solutions requires the practitioner to be in touch with both the
patient and other health care professionals who are involved in caring for the patient and with
whom the practitioner has a direct contact.

The intellectual process of transposition-conception is only solicited by osteopaths who are using
their practice for research or development purposes. In normal practice this process is not used.

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                         7

Through the intellectual process of application, osteopaths have a relationship with time. Their
action requires them to make decisions and to judge their own work before proceeding further. In
other words, osteopaths decide upon the rhythm and frequency of consultation according to the
presenting complaints that they need to address and the progress of the patient that they need to
monitor. The notion of treatment duration cannot be determined in advance.

The notion of variety of action is equally present as the osteopathic process is characterised by
patient individuality. For the same reasons, osteopathic practice is characterised by unexpected
situations, as are all health care professions, as one cannot predict in advance what may occur
during the daily routine.


This is not a dominant feature in practice, but may occur. The patient and practitioner do not
consider urgency in the same manner. In osteopathy, urgency is often subjective and is only
exceptionally linked to reactivity in the case of a potentially fatal prognosis.


Interaction is a permanent feature which is necessary in order to resolve problems which may arise
during other dominant activities. The type of interaction is “as and when presented with… ”, as
work can only advance according to information which is given by the patient or other health care
professionals involved with the patient.


In the dominant activities of osteopathy, an osteopath does not delegate work. In other words,
they will not engage another person to perform part of the therapeutic intervention.


As for the other criteria, it is the role that these points of reference play in osteopathic activity which
is analysed, rather than the details. With reference to the list for the “Operational Directive for
Professions and Work “ the points of reference concerning osteopathic activity are:

   •   Secretarial              : level 3 *(see levels of competence, Ch3.1, p6)
   •   Law                      : level 4
   •   Finances                 : level 3
   •   Management and accounting : level 3
   •   Hygiene                  : level 2
   •   Psychology               : level 3*
   •   Natural sciences         : level 2*
   •   Medical sciences         : level 2*

* minimum requirement, if the activity takes place as part of a research project or in higher

                                    STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                            8

With reference to the above mentioned list, the field of application of osteopathy is within the
medical domain. There exists a certain similarity in the logic and professional identity of
osteopathy and other medical professions.

As the types of process mentioned are all related to intellectual understanding, the psychology of
the individual may seem to be neglected. Even though this is of primordial importance in
osteopathic clinical practice, as the practitioner is solicited through their ability to relate to their
patient, the psychological process is not considered adapted to a description of the areas of
capability of an osteopath.

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                          9

A- Concepts and principles of osteopathy.

B- Knowledge relevant for the safe and competent practice of osteopathy.

C- Cognitive skills in understanding the points of reference in osteopathic thinking.

D- Therapeutic and professional relationships.

E- Personal and individual skills.

F- Communication skills.

G- Information and data handling skills.

H- Intra and inter professional collaboration and co-operation.

I-   Professional identity and ethics.

J- Responsibility and accountability.

K- Professional self evaluation and development by means of reflective practice.

L- Identification and evaluation of the needs of the patient.

M- M Acquisition and enhancement of the skills of osteopathic palpation.

N- Planning and justification of osteopathic treatment interventions.

O- Monitoring of osteopathic interventions and commitment to the patient.

P- Conducting osteopathic treatment and patient management.

Q- Evaluation of post treatment progress and change.

R- Advice and support for the promotion and maintenance of healthy living.

S- Managing an efficient and effective environment for the provision of osteopathic health care.

                                STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                     10

The osteopathic concept is characterised by the importance given to the relationships between
different body structures, the consideration of the body as a structural and functional unit in motion,
and the notion of the unique nature of each person.

For each individual, osteopathy aims to take into account the cause rather than the manifestation
of disturbance within the auto-regulatory mechanisms of the body, with the aim of promoting
homeostasis and the physiological processes of healing.

The therapeutic vector is essentially to improve mobility in the structures of the body concerned, by
the use of manual techniques.

These techniques aim to enhance exchange within the tissues themselves in order to improve
mobility, trophicity and function.

The concept and principles of osteopathy should be applied in order to :

      •     obtain, evaluate and utilise the clinical findings concerning a patient,


      •     improve or maintain a patient’s state of health, or otherwise advise them on these matters

                           The osteopath should be able to demonstrate :

A.1       A commitment to considering the patient as a total being and searching for the cause of ill-

A.2       An understanding that the presenting problem may mask underlying pathologies.

A.3       An understanding of the principles and concepts of osteopathy and how these inform and
          guide rational clinical decision-making.

A.4       An understanding of how osteopathic principles are expressed and translated into action
          through a number of different osteopathic treatment approaches and how to select or
          modify techniques to meet the needs of an individual patient.

A.5       An awareness of the areas of capability and limits of osteopathy as well as it’s
          complementarity with other therapeutic disciplines.

A.6       An understanding of the supportive role played in the physiological healing process and an
          awareness that osteopathic intervention reaches its limits when it is no longer able to give
          relief for presenting symptoms.

                                     STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                       11

The principles of osteopathy based on the legacy of A.T. Still, on which the concept of osteopathy
is built, are consolidated by knowledge based on modern scientific findings.

Osteopathy is based essentially upon an analysis of human dynamic functioning and the impact
that this has on the individual’s anatomy and their interaction with the physical environment.

This analysis forms the basis for an evaluation of the state of health of the patient through the
recognition of disease and pre-pathological states.

This knowledge should be continually refined in order to:

      •     inform clinical reasoning and decision making,


      •     guide the selection, application and evaluation of osteopathic treatment.

                           The osteopath should be able to demonstrate :

B.1       A detailed and integrated knowledge of human structure and function, with special
          emphasis on the neuro-musculoskeletal system, sufficient to recognise, identify and
          differentiate between normal and abnormal anatomical structures and processes in the
          living body.

B.2       A knowledge of human disease sufficient to recognise disorders not amenable to
          osteopathic treatment

B.3       The use of the principles of biophysics sufficient to understand the effect of forces acting
          within living matter especially in the effective use of such forces in the application of
          osteopathic techniques

B.4       A knowledge of human psychology and sociology, sufficient to understand their effect on
          the patient’s state of health.

B.5       A knowledge of the effects of medication.

B.6       A knowledge of modern validated scientific data and integration of this knowledge in terms
          of its relevance to the founding principles of osteopathy, during professional activity.

                                    STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                       12

Osteopaths should possess a deep and thorough understanding of the points of reference in
osteopathic thinking.

They may work within and up to the professional limits of their art.

They should know how to resolve a complex problem using systematic analysis and should have a
suitable capacity for:

   •    professional conduct in working conditions which may be unpredictable, require sound
       judgement, initiative action and personal responsibility,


   •   pursuing a personalised and original approach to this discipline

                         The osteopath should be able to demonstrate :

C.1     An independent approach to the synthesis of information received, and the management of
        responses given.

C.2     Technical skill which allows him/her to face unforeseen or unusual circumstances.

C.3     A high sense of responsibility for themselves and their patients.

C.4     A critical analysis of their activity and personal development.

C.5     Interaction and communication with osteopathic colleagues and other professional bodies.

C.6     A strong consideration of ethical problems associated with the practice of the art of

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                      13

The therapeutic relationship in osteopathy is characterised by a distinctive dialogue between
practitioner and patient as the osteopath will listen to, examine, advise and treat the patient with
the use of informed touch (hand to body contact)

This therapeutic relationship, which goes much further than simply technical intervention, demands
mutual trust and confidence between patient and osteopath, in accord with the ethics and code of
practice of this profession.

Osteopaths must acquire competence, sensitivity and cultural awareness which will enhance an
understanding of the value of the person and the issues concerned with osteopathic practice.

It is vital that the therapeutic relationship is sincere, caring and sufficiently comprehensive in order

      •     reconcile technical ability, humanity, dignity and accuracy of treatment,


      •     respond equally to specific needs associated with physical, mental, cultural and religious

                           The osteopath should be able to demonstrate :

D.1       A willingness to establish an autonomous and reciprocal relationship with the patient.

D.2       A strong commitment to ethical issues and a systematic concern for quality, integrity,
          tolerance and respect.

D.3       A suitable understanding of the relationship between patient and practitioner in order to
          respect the emotional domain of the patient and conform to professional ethics.

D.4       A strong commitment to maintaining patient confidentiality in accordance with the law and
          in compliance with the Code of Practice established by the profession.

D.5       A commitment to inform the patient clearly, honestly and in an appropriate manner in order
          to obtain their informed consent prior to any osteopathic intervention, in accordance with
          the law and in compliance with the Code of Practice established by the profession.

D. 6       A range of integrated skills and self awareness sufficient to manage clinical challenges
          effectively in unfamiliar circumstances or situations.

D.7       A commitment to the development of evaluating osteopathic practice.

D.8       A commitment to avoiding osteopathic practice in situations which may compromise the
          health and safety of the patient in particular where the health of the osteopath is
          incompatible with professional practice.

                                     STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                        14

Osteopaths must have a realistic insight into their personal strengths and limitations.

Osteopaths need to think and operate with a three dimensional vision of anatomy and mobility and
have an awareness of the dimensions within which we exist as human beings, in order to apply the
concept and principles of osteopathy.

Critical self reflection should be developed to a high level in order to:

   •   guide the effective use of clinical reasoning skills and clinical problem solving skills


   •   manage clinical uncertainty both ethically and effectively.

                          The osteopath should be able to demonstrate :

E.1    A level of spatial awareness of anatomy and mobility and a critical self awareness
       compatible with the high standards of osteopathic care.

E.2    An ability to interpret clinical findings and a level of reasoning that allows for effective
       decision making compatible with the safe delivery of high standards of osteopathic care that
       the patient should be able to expect.

E.3    An awareness that counter-transference may exist within the patient –practitioner
       relationship, and that this should be dealt with in an ethical manner.

E.4    A compassionate approach in the understanding of the patient, combining attention,
       availability, humanity and dignity.

E.5    An appreciation of personal and professional strengths sufficient to promote active and
       planned self development.

E.6    A commitment to evolve through engagement in continuing professional development,
       research or assisting personal development of colleagues.

                                    STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                    15

Effective and efficient communication is a key requirement for the delivery of high quality
osteopathic care.

It is primarily confined to interactions between the patient and the osteopath but may also extend to
the patient’s family or chaperone, as well as osteopathic colleagues and other healthcare

Osteopaths must be able to communicate with the public at large in order to inform them about
general health and hygiene issues.

Osteopaths must have highly developed interpersonal skills of communication, based on tolerance
and supported by knowledge of relevant published research, with the aim of:

  •    responding to patients from diverse ethnic and cultural backgrounds and age groups, and
      their different expectations,


  •   guiding clinical reasoning and professional development

                        The osteopath should be able to demonstrate :

F.1    An appreciation of the range and forms of human communication and their strengths and
       limitations in specific clinical encounters.

F.2    An understanding that the information given by the patient is of fundamental importance in
       the therapeutic relationship and that this information should be clear, reliable and

F.3    The ability to select and move between different forms of communication depending upon
       the situation, and to give comprehensible information.

F.4    Skill in relating, integrating and responding to information and data and an ability to
       summarise relevant information.

F.5    An ability to communicate with other healthcare professionals involved in caring for the
       patient in order to ensure continuity in care.

F.6    An ability to speak from an informed perspective about osteopathy, its limitations, strengths
       and potential, and adapt this to different publics.

F.7    That their professional communication is not used for publicity or personal promotion, either
       directly or indirectly.

F.8    The ability to discuss and critically evaluate research and other findings concerning the
       efficacy and application of osteopathic interventions, as well as the therapeutic claims of
       other healthcare disciplines.

F.9    A capacity to integrate and propagate recommendations concerning clinical practice.

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                       16

To deliver high quality health care, it is no longer sufficient for the osteopath to simply interact with
a patient.

Osteopaths must be able to record and present their findings accurately.

They must be capable of locating, selecting and acquiring information as necessary in order to:

   •   respond to the demands and expectations of different parties concerned by this profession,


   •   supply evidence of compliance with the requirements of the statutory body or in response to
        litigious challenges.

                         The osteopath should be able to demonstrate :

G.1    A level of skill in the use of information technology consistent with effective and efficient
       management of a modern osteopathic practice.

G.2    A basic standard of word-processing skills consistent with the production of written reports
       and presentations of high quality for referral and related purposes.

G.3    An awareness of managing and presenting financial and other data needed for compliance
       with legal requirements

G.4     An awareness of the manipulation of quantitative and qualitative data for audit purposes as
       well as effective use of data access and retrieval facilities necessary for the organisation of
       continuing professional development.

G.5    An awareness of jurisdiction concerning osteopathy and healthcare professions in general.

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                           17

Osteopathy can no longer operate in isolation from other health care professions.

An osteopath’s status as an independent practitioner and primary contact health care provider
necessitates a co-operation with other health care professionals.

Increasingly patients are being referred by other health professions, often without any specific
medical prescription.

Osteopaths need to be sufficiently well informed in order to:

  •   critically evaluate the advantages, limits and claims of their profession,


  •    develop a mutual regard between healthcare professions for their respective potential
      contribution to the well being of an individual patient.

                         The osteopath should be able to demonstrate :

H.1    A critical appreciation of the context, contribution and limits of osteopathy in France and

H.2    A commitment to maintaining the cohesion and efficacity of the French public health

H.3    A critical awareness of the specific claims of a range of conventional and non-conventional
       health care professions and how these relate to osteopathy.

H.4    An awareness of the need to participate effectively in the planning, implementation and
       evaluation of multi-professional approaches to health care.

H.5    An awareness of the principles and practice of other health care professions.

H.6    A mutual tolerance and respect in inter professional relations.

H.7    Respect for the Code of Practice established by the profession.

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                     18

Osteopathy is characterised by its unique expertise that is complementary to other health care

Osteopathic practice recognises the primacy of the patient and their fundamental right to have
access to high quality care, respect for them as a person, their life and their dignity, and protection
from abuse of any kind.

The profession establishes the standards by which:

      •   entrants to the profession are selected, prepared and assessed


      •   professional osteopaths maintain and develop a high level of competence and safety.

                            The osteopath should be able to demonstrate:

I.1       A commitment to pursue osteopathic practice with respect for the patient, their life, dignity
          and rights.

I.2       An ability to act at all times in such a way as to respect the independence of the patient.

I.3       Respect at all times for moral principles, integrity, dedication and competence in all
          professional circumstances.

I.4       A commitment to provide continuity in care and a guarantee to patients of equal access to
          urgent, unplanned treatment.

I.5       A commitment to guarantee that all patients will receive appropriate treatment for their

I.6       A commitment to avoid putting patients unnecessarily at risk in terms of the benefits
          expected from the treatment.

I.7       The same care and attention for each patient whatever their individual characteristics

I.8       An understanding that the quality and improvement of care relies essentially upon the
          actions of health care professionals.

I.9       An appreciation of the significance of the personal professional role in terms of the
          expectation to practise osteopathy safely, competently and lawfully.

                                     STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                         19

Each osteopath is responsible for delivering competent, safe osteopathic care of a high quality
within the framework established by law.

A regulated professional status requires a total commitment by the osteopath to respect the current
laws and regulations.

The profession establishes the standards and methods by which:

  •    it acquires and maintains a register of all practitioners who meet the general requirements
      for practice,


  •   it monitors the implementation of the current regulations by its members.

                         The osteopath should be able to demonstrate:

J.1    That they fulfill the conditions which enable the title of osteopath to be used, and allow the
       practice of osteopathy in France, as will be defined by the decree to be established
       according to Article 75 of Law No. 2002-303 of 4th March 2002, or by any subsequent
       legislation (in particular the creation of a “professional order” and the obligation in this case
       to be registered with the Charter of this order as is the case with other professions who
       have such an order).

J.2    Acritical understanding of the legal responsibilities and commitments of an osteopath.

J.3    A commitment to abide by the Code of Practice as well as all other regulations specific to
       the profession.

J.4    A justification of all actions performed within the framework of osteopathic practice.

J.5    A complete understanding of the contract of professional secrecy and its legal implications.

J.6    A commitment to maintaining the integrity of the profession and not bringing it into disrepute
       by claiming qualifications, skills, experience or knowledge not possessed or with no right to

J.7    A commitment to supply information required for the maintenance of regulations within the
       osteopathic population.

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                          20

All osteopaths must be committed to fulfilling the requirement of continuing professional

They should consciously and honestly recognise and evaluate their own limitations regarding
knowledge, skills and experience.

Osteopaths must appreciate the need for continuing professional development as an integral
aspect of their working life in order to :

  •    plan and develop personal professional action plans to maintain and enhance their
      osteopathic capability.


  •   ensure the retention of registered status.

                        The osteopath should be able to demonstrate :

K.1    Personal reflection concerning clinical activities and the outcome of self-monitoring.

K.2    An awareness of the need for continuing professional development.

K.3    An understanding of the different forms of personal development that exist, and the areas
       covered by continuing professional development.

K.4    Participation in continuing professional development activities.

K.5    An awareness of the need to be able to participate in, and contribute to, structured courses
       and conferences with the aim of personal development and an improvement in the
       understanding of the patient –practitioner relationship.

K.6    An appreciation of the need to generate and submit self-audit reports to the standard
       required by the statutory body from time to time.

K.7    An awareness of the need to implement procedures which aim to evaluate and improve the
       quality of professional practice.

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                      21

Osteopaths must be able to operate within an efficient and high standard practice environment
conducive to establishing an effective and secure therapeutic relationship with each patient.

They must be able to identify the needs of a patient and record the key findings accurately with
appropriate detail.

They must be able to conduct a thorough and detailed physical examination and interpret the
clinical findings and other relevant details in order to:

  •     inform clinical reasoning and formulate a specific osteopathic diagnosis,


  •     decide upon and justify the most appropriate treatment plan.

                          The osteopath should be able to demonstrate :

L.1       Effective and efficient completion of a detailed case history of the patient and an analysis
         of the patient’s presenting complaint as well as a recognition of the relative importance of
         psychosocial, emotional and nutritional aspects of the patient.

L.2      The ability to conduct a standard clinical examination including case history taking,
         observation, percussion, palpation, auscultation, generally performed in that order.

L.3      The ability to conduct a static and dynamic biomechanical assessment, and detailed
         palpatory evaluation as well as the appropriate arrangement for specific clinical
         investigations as required.

L.4      An awareness of the issues of ethnicity, gender, religious beliefs and socio-economic status
         and their impact on the patient’s health and the evaluation of their needs.

L.5      A capacity to integrate the results of the investigations according to the environmental
         context of the patient.

L.6      An ability to effectively consult with the patient at all stages of the evaluation and to
         recognise the characteristics and consequences of non-verbal communication.

L.7      The ability to generate a number of hypotheses to explain the patient’s presenting
      complaint to aid the formulation of a treatment plan or onward referral.

L.8      An ability to produce complete and accurate records of the outcomes of the patient

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                        22

A defining characteristic of osteopaths is their effective use of a highly developed and refined skill
of palpation.

This high level of perception requires a methodical acquisition, and should be continuously
maintained through self evaluation and personal development.

Palpation is one of the primary communication channels for most osteopaths, which allows them to
undertake their professional interactions with patients in order to:

   •   obtain clinical findings, treat and evaluate the changes that have taken place,


   •   detect and respond to physiological changes at all levels in the body.

                         The osteopath should be able to demonstrate :

M.1    A high level of palpatory skill and a critical appreciation of the therapeutic value of touch
       and palpation.

M.2     An advanced knowledge of palpatory characteristics of the structure of discrete body
       tissues and their normal and abnormal functioning.

M.3    A commitment to use palpation selectively, in conjunction with other diagnostic and
       therapeutic methods.

M.4    An ability to use palpation as a diagnostic and therapeutic medium as well as for monitoring
       the effects of treatment.

M.5    An ability to keep accurate and appropriate records of palpatory findings.

M.6    a commitment to exemplary conduct when using palpation with the informed consent of the

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                         23

Osteopaths must be able to formulate an efficient and justifiable osteopathic treatment plan.

If necessary osteopaths should propose an alternative course of action including referral to an
appropriate healthcare professional.

These two plans of action should be based on:

  •    critical consideration of all the facts and findings derived from the case history, clinical
      examination and other relevant information including tests from external sources,


  •    effective use of explanations using suitable vocabulary and levels of detail, according to the
      patient’s level of expectation and that of other professional health care colleagues.

                        The osteopath should be able to demonstrate :

N.1    A detailed analysis and reflection on information gathered during case history taking and

N.2    The generation and justification of a number of hypotheses for the aetiology of the patient’s
       presenting complaint.

N.3    The selection of an appropriate course of action based on a rational decision-making
       process which includes a critical consideration of personal limits of competence, the
       possibilities offered by the tissue quality of the patient, the likely effects of osteopathic
       treatment and the wishes of the patient.

N.4    The ability to decide whether or not to treat the patient and if not, select the most
       appropriate course of action.

N.5    An ability to identify and reflect upon any obstacles to the treatment plan and progress, and
       to undertake appropriate action.

N.6    An ability to formulate a complete and accurate record of therapeutic interventions
       undertaken, and an ability to produce letters and other forms of communication with other
       health care professionals.

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                        24

Osteopaths must be committed to preserving the safety and wellbeing of the patient.

The proposed course of action must be planned within the context of the anticipated outcomes, the
expectations of the patient and their informed consent.

Osteopaths must gain the trust and co-operation of the patient in order to:

  •    obtain a response and give explanations using suitable vocabulary in recognition of the
       patient’s own level of understanding and expectation.


  •   determine possible contra-indications to the use of certain osteopathic interventions.

              The osteopath should be able to demonstrate:

O.1    The formulation of a comprehensible and detailed treatment plan and prognosis.

O.2    The means by which to inform the patient of findings and intended course of action.

O.3    The ability to integrate information gained through non-verbal communication.

O.4    The ability to manage potential situations of counter transference.

O.5    The ability to enter into a formal therapeutic contract with the patient.

O.6    A commitment to maintaining an exemplary ethical conduct, including situations where
       clinical problems place practitioner and patient in a difficult situation or where there is
       personal incompatibility.

                                   STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                    25

Osteopaths must be able to justify the selection and use of any form of osteopathic technique or its

They must be able to recognise the factors and moments where a specific form of osteopathic
intervention is absolutely contra-indicated and to adopt alternative and effective approaches
including referral of the patient to another health care professional if necessary.

Osteopaths should honestly, thoughtfully and responsibly monitor the responses to treatment by

  •  changes in the patient compared to the original clinical findings, and verbal or non-verbal
  • the course of action of previous interventions, which have been documented in the case
    notes of the patient.

                        The osteopath should be able to demonstrate :

   P.1 The ability to select and use a wide range of osteopathic techniques and patient
   management approaches.

   P.2 A thorough and critical understanding of the theory, principles and practice of osteopathy.

   P.3 An awareness of the indications and contra-indications of using specific osteopathic
   techniques or their modification.

   P.4 The ability to adapt an osteopathic technique and justify its use in relation to the palpatory
   feedback received from the patient’s tissues.

   P.5 An ability to justify the selection and mode of use of an osteopathic treatment or approach
   for the care of an individual patient.

   P.6 Commitment and ability to monitor stringently the effect of treatment during, and wherever
   possible, after its application.

   P.7 An ability to restore patient equilibrium in the case of an unexpected reaction to
   osteopathic treatment.

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                         26

Osteopaths must be committed to continuous self-evaluation of their professional actions and

This is especially relevant to their assessment of the health status of a patient following a planned
osteopathic intervention.

Osteopaths need to maintain an honest and thoroughly accountable approach to the evaluation of
the level of outcome experienced by the patient.

In this situation they must:

   •    recognise and deal with expected and unexpected changes to the patient’s health and
       incorporate their evaluation of these into a revised form of intervention negotiated with the

   •   produce accurate recording of factual evidence derived from evaluation of the patient.

                          The osteopath should be able to demonstrate :

Q.1     The ability to gather and organise a comprehensive range of qualitative and quantitative
        data and evidence relevant to the response of an individual patient to an osteopathic

Q.2     A justification for the decision to continue, modify or cease osteopathic treatment based
        upon the critical consideration of the evidence acquired during the evaluation of the patient
        and any other relevant factors.

Q.3     Tthe ability to recognise adverse reactions to osteopathic treatment and to initiate
        appropriate responses including referral.

Q.4     An open minded approach and acceptance of treatment outcome that does not conform to
        expectations but may offer deeper insight to the clinical meaning of the patient’s presenting

Q.5     The ability and commitment to record evaluation findings and their interpretation accurately
        and accessibly in the case notes of an individual patient.

Q.6     A commitment to continuous and deliberate self-monitoring to identify the potential
        influence of unintended effects e.g. counter-transference, whilst conducting a treatment

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                        27

A guiding principle of osteopathy is to ensure that the patient’s body regains as much of functional
integrity of its inherent structure as possible.

For many patients this will mean a commitment to adopting a healthier lifestyle.

Osteopaths must be able to offer constructive and realistic advice and guidance to individual
patients to help them to consolidate and, where possible, enhance their health status following
osteopathic treatment.

For this purpose they need to:

  •    be able to advise patients about coherent prophylactic routines or access to other forms of
      complementary healthcare that have been scientifically evaluated,


  •   respect the claims and limitations of osteopathy as well as the efficacity of the French
      National Health Service.

                        The osteopath should be able to demonstrate :

R.1    A critical appreciation of the key concepts and organisation of health education and health
       promotion used in France and abroad.

R.2    An understanding of the significance and potential effect of psychosocial and economic
       factors in helping patients to make informed choices about their personal healthcare

R.3    An ability to assist patients to undertake and become committed to self-care activities
       including exercise and lifestyle adjustments, without encroaching on their personal liberty to
       choose how these changes may be implemented.

R.4    The ability to offer realistic advice concerning the location and effective use of local
       healthcare promoting activities consistent with cultural and ethnic differences.

R.5    An understanding of the importance for the practitioner to maintain health and care for
       themselves as an exemplar of health and well being.

R.6    An awareness of the potential benefits and limitations of referring an individual patient to
       other healthcare practitioners.

                                  STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                        28

Osteopaths should be able to practise in a high quality environment which facilitates an efficient
and safe therapeutic relationship with each patient.

Osteopaths must be able to manage and organise an osteopathic practice efficiently and
effectively to ensure that only high standards prevail for patient care.

They must be in full compliance with statutory regulations, external contractual obligations, legal
requirements and the contract of confidentiality with their patients. For these purposes they must:

  •   be accountable and responsible for the effective keeping of patient and other records,


  •   monitor the adherence to, and conduct such processes as necessary in order to conform to
      Health and Safety regulations.

                        The osteopath should be able to demonstrate :

S.1    An awareness of the need to comply with the legal requirements of operating a modern
       osteopathic practice with the necessary facilities for patient and staff comfort.

S.2    An awareness of the need to maintain financial and other practice operation details in
       accordance with legal and ethical requirements.

S.3    An awareness of the need to monitor the quality of practice and the ability to contribute to
       the generation of operational and strategic plans.

S.4    The effective maintenance of patient records and information in compliance with legal and
       ethical requirements.

S.5    An awareness of the need to generate effective and high standards of contact with external
       agencies such as other health care professionals, insurance companies or other

S.6    A commitment to replying to a patient’s demand for records, in accordance with the
       conditions stipulated in Law 2002-303 of 4th March 2002, or any other law or regulation
       which may come into being.

                                 STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                       29
An osteopath studies, prevents and treats disturbances in the auto-regulatory mechanisms of children, adults and the
elderly. This is achieved using specific analysis, elaboration of a therapeutic plan and the use manual techniques to
restore an overall organic function.
In certain situations, an osteopath may participate in teaching or research.

An osteopath acts in collaboration with the patient, and in conjunction with other health care professions.
The Code of Practice and contract of professional secrecy must be respected.
Osteopathic intervention necessitates direct contact with the patient and frequent changes of position.
Osteopathic activity is conducted the majority of the time in a private practice.
It is not reimbursed by the French National Health Service.
Practice hours may be long and sometimes late in the evening in order to accommodate patients.

The profession requires a course of study up to level 1, plus validation of the Diploma in Osteopathy. Medical doctors
and other paramedical professionals who hold a State Diploma may access the course at different stages according to
the equivalent study that they have already validated.


     •  To inform themselves of the patient’s                 •  Locomotive apparatus
        symptoms, past medical history and                    •  Autonomic nervous system
        environment,                                          •  Digestive system
     •  To examine the patient globally and                   •  Genito-urinary system
        analytically,                                         •  Cardio-vascular system
     •  To diagnose the existence of a functional             •  Ear, nose and throat complex
        disturbance,                                          •  Respiratory system
     •  To decide upon the treatment to be
        administered,                                      PUBLIC CONCERNED
     •  To refer to another health care professional          •   Children
        if necessary,                                         •   Adults
     •  To keep up to date records concerning                 •   Elderly
     •  To give advice concerning posture and              RESPONSABILITIES
        healthy living,                                       •  Management of a small working unit
     •  To help prevent an illness from developing            •  Reception and teaching of students
                                                           OTHER ACTIVITIES
ASSOCIATED COMPETENCE:                                        •  Teaching
   •  To have knowledge of surgical and other                 •  Research
      medical interventions,                                  •  Specialisation
   •  To have knowledge of human sciences,
   •  To have an understanding of management               LOCATION OF ACTIVITY
      and accounting,                                            Private practice,
   •  To use information technology.                              hospital environment,
                                                                 sports club….
    •   To listen to, inform and reassure the patient,
    •   To synthesise information in order to make
        rapid and efficient decisions,
    •   To remain neutral and objective in the
        palpatory relationship with the patient,
    •   To have a clear representation of space,
    •   To be able to cope with standing and other
        postures       associated     with    complex
    •   To permanently monitor and improve
        practical skills.

                                          STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                                 30
                                                        6) VALIDATION COMMITTEE

The National Council would like to thank the members of the validation committee for their
suggestions which have contributed to this document:

   •   Mr. Alain Andrieux
       Ex President of the Union Fédérale des Ostéopathes de France

   •   Mr. Robert Hiriart
       Ex member of the committee for ethics and professional conduct.

   •   Mr. Xavier Johannes
       Ex Vice president of the R.O.F., responsible for ethics and professional conduct.

   •   Mr. André Loiseau
       Ex Vice president of the R.O.F., responsible for ethics and professional conduct.

   •   Mr. Serge Majal
       Ex Président of the R.O.F.

   •   Mr. Christian Marc
       Ex committee member for ethics and professional conduct, ex President of the Association
       Française des Ostéopathes.

   •   Mr. Robert Perroneaud-Ferre
       Founder and ex President of the R.O.F.

   •   Mr. Bertrand Rochard
       Ex member of the committee for ethics and professional conduct, ex President of the Association
       Française des Ostéopathes.

   •   Mr. Daniel Sirieix
       Ex President of the R.O.F.

   •   Mr. Raymond Solano
       Ex President of the R.O.F.

   •   Ms. Ildiko Somody-Neplaz
       Ex Vice president of the R.O.F., responsible for ethics and professional conduct

   •   Mr. Gérard Sueur
       Member of the French Academy of Osteopathy, department of Human Sciences in Osteopathy

   •   Ms. Elisabeth Tissot
       Ex Vice president of the R.O.F., responsible for ethics and professional conduct

   •   Mr. Gérard Vanhersel
       Ex spokesman for the committee of ethics and professional conduct

                                    STANDARD OF PROFICIENCY IN OSTEOPATHY 2004                       31